Family Camp Weekend

May 30th to June 1st, 2014

Outdoor Family Fun! Strengthening Family Connections, Friendships and Memories. SASAMAT OUTDOOR CENTRE 3302 Senkler Road, BC Belcarra, BC V3H 4S3

Program Starts: 6:30pm Friday May 30th Program Ends: 3:00pm Sunday June 1st

REGISTRATION PACKAGE
For more information contact Brigette, Family Camp Worker at brigettebouchard@shaw.ca or call 604-736-3588 To Register visit the Kits House Office at 3683 West 4th Ave Monday-Friday 9am-5pm. Cash or Cheque only.

Register early, space is limited!

www.kitshouse.org

INFO SHEET: Family Camp Weekend 2014

Cost of Family Camp: Fees Adults (19 years+) $115.00 Youth (13-18 yrs) $ 95.00 Children (5-12 yrs) $ 85.00 Toddler (1-4 yrs) $ 75.00 Infants (0-12 months) Free Family Membership Fee $ 20.00 Empty Bed Charge $ 50.00 Transportation (Kits House Van) $ 12.00 / person ($6.00 each way) * Note: Actual cost for camp is $115 per person (for anyone over 1 year of age) Things you need to bring: Sleeping bag or warm blankets & a pillow Toothbrush, tooth paste and toiletries Flashlight Books, board games, etc. (for time fillers & entertainment) Clothes for 2.5 days (Sweaters, long pants, runners - one pair for walking & one pair you dont mind getting wet) Rain gear (jacket & pants if possible) Swim suit & towel (optional) Things you should know: Prices include: meals, accommodations, & activities All meals will be provided: Friday light snack, Saturday breakfast, lunch & dinner and Sunday breakfast & lunch All participants will be asked to sign-up for a Volunteer Task There is a $50 charge for empty beds - if you require your own cabin All belongings should be labeled & put into a sturdy bag Non-prescription drugs, alcohol & pets are not permitted on site If you are providing your own transportation to Sasamat Outdoor Centre, please arrive after 6:30 p.m. on Friday May 30th, 2014 Parking space at Sasamat Outdoor Centre is limited, so please try to carpool Kits House Van Transportation: Families that are registered to travel in the Kits House Van need to arrive with their luggage no later than 4p.m. on Friday May 30th, 2014 **Registration for Family Camp Weekend is on a first come first served basis**

DIRECTIONS TO SASAMAT OUTDOOR RECREATION CENTRE

How to get here
From the corner of St. John's Street and Ioco Road in Port Moody, turn North onto Ioco Road. Turn left at the third traffic light and follow the signs to Belcarra Regional Park. Turn right onto 1st Ave. which becomes Bedwell Bay Road. Drive past the turnoff to White Pine Beach. Turn right at the stop sign, towards the Village of Belcarra. Finally, turn right onto Senkler Road, the first road to your right after entering the Village of Belcarra, and follow the wooded driveway into Sasamat Outdoor Centre. Translink Belcarra/Port Moody - #C26 If you are taking the Translink Shuttle Link: http://sasamat.org/directions.html

Sasamat Outdoor Centre

Camp Site Map

Registration Form
Full Name of Participants:
Adult: __________________________________________________ Adult: __________________________________________________ Child: ______________________________________age: ________ Child: ______________________________________age: ________ Child: ______________________________________age: ________ Child: ______________________________________age: ________ KNH Van Transportation: (# of participants _____ x $12): KNH Family Membership ($20):

Fee Amount:
________________ ________________ ________________ ________________ ________________ ________________ ________________ ________________ ________________

Contact Information:

Total Fees:

Address: _______________________________________ Postal Code: _________________

City: ________________________

Phone #: _____________________________ Cell #: _____________________________

E-mail: ___________________________________

Questions:
1.Accommodation PreferenceCOTTAGE (4)

/ CABIN (6) ?
If yes, how many: _____

2.Diet Restrictionsplease specify any allergies we should be aware of: _______________________________________________________________________________ 3.Car Poolingare you able to drive another family? Y / N

For Office Use Only: (check all information that applies)

Registration Form Medical Form

Amount Paid:_______ Membership #:______

KNH Van Registration Subsidy Form KNH E-Newsletter

Waiver / Release Form Receipt #:__________

Waiver / Release Form

I / we agree that members of our family will follow all reasonable instructions and directions of the leaders and instructors duly appointed by the Association of Neighbourhood Houses (ANH) in connection with the operation of the Family Camp Weekend on May 30th to June 1st, 2014. I / we hereby release, and forever discharge ANH and its agents or volunteers, of and from all manner of action, cause of actions, claims and demands of whatever nature which result from any accidental injury, loss or expense sustained, arising out of in any way connected with participation in any program, or attendance at any location operated by ANH. In the event that my child is injured, ill or in need of medical attention and I am unable to be contacted, I authorize KNH staff to seek medical attention on my behalf. I / we authorize or do not authorize [circle one] Kitsilano Neighbourhood House (KNH) to use and publish testimonials, feedback, photographs and video taken of me / family / child(ren) while participating at Family Camp, for use in promotional materials, including but not limited to: posters, website, social media, and advertising. This waiver release includes the right to modify and retouch the above in the tasteful discretion of Kits House staff. I understand that there will be no compensation to me for this use. PRIVACY STATEMENT Kitsilano Neighbourhood House and the Association of Neighbourhood Houses respect your familys privacy. The information collected on this form is in compliance with the BC Personal Information Protection Act and is used to process program registration, help ensure the safety and well being of members and to provide you and your family with information on events and programs at Kitsilano Neighbourhood House. If you have any questions or would like a copy of the ANH Privacy Policy please contact our office at 604-736-3588. Kitsilano Neighbourhood House reserves the right to cancel a program if there is low attendance or registration. A full refund will be issued for any program cancelled.

___________________________________________ Name of Parent / Guardian (please print) ___________________________________________ Signature of Parent / Guardian _________________ Date

Medical Form
**A Medical Form is needed for every family member**

Medical Form
**A Medical Form is needed for every family member**

Medical Form
**A Medical Form is needed for every family member**

Medical Form
**A Medical Form is needed for every family member**